Racist Requests: How Should Hospitals Treat Patient Bias?

Teoka Williams, a nurse working the midnight shift at Beaumont Medical Center in Dearborn, Mich., had just finished assessing her patients when she overheard one of them say she didn’t want a “black b**ch” taking care of her.

That’s according to Williams’ complaint filed in the U.S. District Court for the Eastern District of Michigan. Williams brought a federal discrimination case after her supervisor complied with the patient’s request and took Williams off the case.

The lawsuit is indicative of a trend employment lawyers in the health-care field are seeing: more complaints on behalf of health-care staff for discrimination at the request of patients.

The problem is so compelling, in fact, that it has been dramatized in popular fiction: a novel by Jodi Picoult, based on a real case brought by a nurse who was barred from caring for a white baby, is being made into a movie with Viola Davis.

Hospital counsel say nondiscrimination law is clear, but that health-care providers must perform a tough balancing act, avoiding discrimination while protecting employees from harassment and considering quality of patient care.

Williams’ attorney, Julie A. Gafkay, who practices in Frankenmuth, Mich., and specializes in employment discrimination cases, thinks the solution is more straightforward. “I think [hospitals] can have a policy and the policy can be what the law is. A patient can’t request services based on race,” Gafkay told Bloomberg Law.

Beaumont Health did not respond to requests for comment.

Best Practices

When a patient makes a biased, potentially unlawful request, hospitals have three main considerations to balance, according to Adam C. Abrahms, a partner with Epstein Becker Green in Los Angeles in the firm’s employment and health law practices.

First, hospitals, like any employer, have an obligation to comply with nondiscrimination laws.

“It is unlawful not to provide somebody an assignment, even in a health-care setting, or provide them with some other assignment based on the racist or other discriminatory demands of a patient or a customer,” Abrahms told Bloomberg Law.

Second, hospitals have to protect employees from harassment. Hospitals have “an equal obligation” to remove employees from situations where they could be subject to harassment, “usually based on the employee’s preference,” Abrahms said.

Hospitals need to “be cognizant that communication can be key,” Abrahms said. Williams alleges her supervisor removed her from the case without getting her input.

Third, according to Abrahms, there is a consideration that is unique to the hospital context: patient care.

Hospitals often need to provide care to “patients that may be undesirable or that we disagree with on many things,” Abrahms said.

“There is nothing wrong with a health-care provider dealing with an alert, competent patient and requiring them to act appropriately,” Abrahms said. “But it becomes more complicated if you have someone who’s not mentally stable.”

“Health-care providers need to look at these issues and provide a balance,” Abrahms said. “These are all very delicate, fact-specific discussions.”

Threats to Patient Care

Gafkay pointed out that hospitals accommodating biased patient requests can actually hurt patient care.

“It’s a detriment to the patient, frankly, because the African-American employee has got the job, she or he is qualified,” Gafkay said. Hospitals can find themselves short-staffed if they accommodate these types of requests.

“What happens when the light goes off for an emergency, and that employee is the only one around?” Gafkay asked.

“In my opinion, what they should have done is Williams’ supervisor should have gone to the patient and instructed her that she would get the best care available and that assignments were not going to be based on race,” Gafkay said. “There are plenty of circumstances where patients go to the hospital and request unreasonable things and those requests are denied.”

EEOC Guidance

The Equal Employment Opportunity Commission settled an analogous case in 2013, Battle v. Hurley Medical Center, the case on which Picoult’s novel is based.

“Assignment of employees based on customer racial preferences violates Title VII of the Civil Rights Act of 1964,” the EEOC wrote in a release accompanying the settlement.

Gafkay said that as her client continues to press her case in court, she is hopeful that patients and hospitals are becoming increasingly aware of what the law is.

“The more it’s in the media, the more people understand that you can’t go to the hospital and request only white staff,” Gafkay said.

“I have seen too many of these cases over the past five years,” Gafkay said. “Unfortunately the more diverse we become as a society, there’s a push back by some who don’t want to see that happen.”

The case is Williams v. Beaumont Health, E.D. Mich., No. 18-12522, complaint filed 8/14/18.